Investigation of differences of sacral and vertebral bone mineral densities before and after radiotherapy in patients with locally advanced rectal cancer.

PURPOSE: Radiotherapy is a treatment method performed using ionizing radiation on cancer patients either alone or with surgery and/or chemotherapy. Although modern radiotherapy techniques provide a significant advantage in protecting healthy tissues, it is inevitable that normal tissues are also located in the areas targeted by radiations. In this study, we aimed to examine the bone mineral density changes in bone structures commonly included in the irradiated area such as, L5 vertebra, sacrum, and femur heads, in patients who have received pelvic radiotherapy; and the relationship between these changes with radiation dose. MATERIAL AND METHODS: Patients included in the study had been previously diagnosed with rectal cancer, which were operated or not. Preoperative or postoperative pelvic radiotherapy was planned for all patients. In terms of convenience when comparing with future scans, all densitometry and CT scans were performed with the same devices. Fifteen patients were included in the study. In order to determine the dose of radiation each identified area had taken after radiotherapy, the sacrum, L5 vertebra, bilateral femoral heads, and L1 regions were contoured in the CT scans in which treatment planning was done. Sagittal cross-sectional images were taken advantage of while these regions were being contoured. RESULTS: Bone mineral density was evaluated with CT and dual-energy X-ray absorptiometry before and after the treatment. The regions that have theoretically been exposed to irradiation, such as L5, sacrum, left to right femur were found to have significant difference in terms of bone density. According to CT evaluation, there was a significant decrease in bone intensity of L5, sacrum, left and right femurs. Dual-energy X-ray absorptiometry assessment revealed that the whole of the left femoral head, left femur neck and Ward's region were significantly affected by radiotherapy. However, there was no significant difference in the sacrum and L5 vertebra before and after radiotherapy. CONCLUSION: More accurate results could be achieved if the same study was conducted on a larger patient population, with a longer follow-up period. When the reduction in bone density is at maximum or a cure is likely in a long-term period, bone mineral density could be determined by measurements performed at regular intervals.

Can radiation-induced chronic oxidative stress in kidney and liver be prevented by dimethylsulfoxide? Biochemical determination by serum and tissue markers.

PURPOSE: To investigate the protective effects of dimethylsulfoxide (DMSO) on chronic oxidative stress in the liver, kidney and serum with biochemical parameters such as malondialdehyde (MDA), advanced oxidation protein product (AOPP), catalase, glutathione (GSH), and free-thiols (F-SH). METHODS: Thirty Wistar albino female rats were randomly divided into 3 groups: group I (control, n=10), group II (irradiation-alone group, n=10) and group III (DMSO and irradiation group, n=10). Rats in groups II and III were irradiated with a single dose of 6 Gy to the entire liver and right kidney. Group III received DMSO 4.5 g/kg by intraperitoneal injection 30 min before irradiation. At the end of the 24th week, the rats were sacrificed and their trunk blood, kidney and liver tissues were collected. RESULTS: Group II rats showed increased levels of lipid peroxidation and protein oxidation, with decreased GSH, FSH and catalase levels in all specimens when compared with group I. Serum and kidney MDA and AOPP levels were significantly lower in group III when compared with group II. However, serum and kidney GSH and F-SH levels were significantly higher in group III when compared with group II. The additive effect on catalase was seen only in the serum. CONCLUSION: DMSO is a protective agent on chronic oxidative stress in the serum and kidney tissue. No oxidant or antioxidant effect of DMSO in the liver was seen.

Chemotherapy and cerebrovascular disease.

Cerebrovascular disease is common in cancer patients. Some tumors are at high risk for cerebrovascular complications. The development of cerebrovascular disease may be provoked by cancer treatment. No well-planned prospective studies about other causes of thrombosis are available, although various case reports about thrombosis related to chemotherapy have been published. L-asparaginase, cisplatin, 5-fluorouracil (5-FU) and methotrexate are anticancer agents which are reported to relate to stroke. The mechanisms by which antineoplastic agents may lead to stroke include endothelium toxicity and abnormalities of coagulation factors. Also, brain hemorrhages that could result from chemotherapy effects on the hemostatic system were reported. Besides, it is difficult to determine whether stroke is caused by chemotherapy or cancer itself. Clinicians deal not only with problems originating from cancer itself, but also with the complications resulting from its treatment. Treatment-induced cerebrovascular disorders affect quality of life and survival in cancer patients. For this reason, cancer treatment should be planned by taking into consideration the possibility of cerebrovascular complications.

Abdominal pillow for the sparing of small bowel in four-field conventional pelvic radiotherapy.

From 2003 through 2004, 88 patients with gynecological cancer were referred to Istanbul University Oncology Institute for pelvic radiation therapy. All patients underwent small bowel evaluation within the pelvic radiotherapy field in both the supine and prone positions with and without an abdominal pillow. The small bowel area included in radiation fields and intestinal movement were compared on PA films. All patients were treated by using the abdominal pillow. The median external beam pelvic radiation dose of 5040cGy (range, 3220-5400cGy) was administered. The mean distance of upward displacement of small bowel in the prone position on abdominal pillow compared with in the prone position alone and in the supine position was 3.6 cm (range, 0-14 cm) and 4.7 cm (range, 0-14 cm). Using the abdominal pillow, the mean small bowel area was reduced by 45% and 55% compared to the prone position alone and the supine position, respectively (p = 0.0001). In patients who had pelvic surgery intestinal movement was significantly reduced. The incidence of G1, G2 and G3 acute radiation toxicity was 18%, 36% and 3%, respectively. This study demonstrates that the small intestines can be displaced out of the radiation field by an abdominal pillow in the prone position. Also, this noninvasive technique provides for reduction of acute gastrointestinal morbidity.

The role of postoperative radiotherapy in node negative breast cancer patients with pT3-T4 disease.

AIMS: To evaluate the role of postmastectomy radiotherapy (PMRT) in patients with pT3-T4N0M0 breast cancer. METHODS: 156 patients with T3-T4N0M0 breast cancer were retrospectively analyzed. RESULTS: Locoregional recurrences were seen in 17 of 156 patients with a median time for development of 27 months (5.7-248.7 months). Two of 9 patients who were not treated with post-operative radiation therapy had locoregional recurrence as compared with 16 of 147 patients receiving radiotherapy. In multivariate analysis, presence of locoregional recurrence was the only significant prognostic factor for overall survival (18% vs. 86%, p<0.001, RR=9.05). The patients with a median number of dissected lymph nodes >or=10 had a significantly better locoregional disease free survival rate as compared with patients with dissected lymph nodes <10 (90% vs. 78%, p=0.04). Chest wall recurrences were clearly higher in patients without chest wall RT since 5 of 49 patients without RT had recurrences in the chest wall region while only 4 of 107 who received chest wall RT had recurrence. However receiving RT to peripherical lymphatic regions had no additional effect on reducing recurrences in these regions (5% vs. 4%). CONCLUSIONS: Due to the lack of phase III randomized trials directly addressing the role of postmastectomy radiotherapy in these stages, our series suggest that postmastectomy radiotherapy to the ipsilateral chest wall is recommended for patients with PT3N0 and T4N0 breast cancer. The need for irradiating axillary or supraclavicular region shall be neglected in patients who undergo sufficient axillary sampling.

Is early postradiation dysplasia almost associated with poor prognosis? A case report and review of the literature.

Following radiotherapy for cervical carcinoma, abnormal cytologic changes have been reported in a number of publications. These reactions occur at varying periods of time following irradiation and do not necessarily reflect the presence of invasive cancer. On the basis of cytologic and histopathologic features, these reactions were determined as postradiation dysplasia (PRD). PRD has been reported to occur in 18.7-26% of patients treated by radiotherapy for cervical cancer. In the literature, it was reported that patients diagnosed with PRD less than 3 years after the initial diagnosis of cervical cancer had a mean survival rate of 33.8% as compared with a 100% 5-year survival rate in patients with a delayed (>3 years) onset of period. We present a case of stage IIIB cervical squamous cell carcinoma with PRD detected 6 months after radiotherapy. The patient is still tumor free 8 years after radiotherapy. In the light of this patient, we review the literature and discuss the relationship of PRD with survival in the cervical carcinomas.

Treatment results and prognostic factors in oral tongue cancer: analysis of 80 patients.

Treatment results and prognostic factors for 80 patients with oral tongue cancer admitted to Istanbul University Oncology Institute between 1987 and 2000 were retrospectively analysed. The patients were treated by surgery and postoperative or curative radiotherapy. Median age was 55 (22-93) out of which 41 patients (51%) were male and 39 (49%) were female. One patient (1%) had stage I disease, 28 patients (36%) stage II, 18 patients (23%) stage III and 32 patients (40%) stage IVA disease. Nineteen patients (24%) were medically inoperable or refused surgical treatment, so were treated with curative radiotherapy to a total dose of 70Gy (group A). The remaining 61 patients (76%) were treated with surgery and postoperative external beam radiotherapy (group B). The median follow-up time was 44 months. The 5-year overall and loco-regional disease-free survival rates were 42% and 46%, respectively. The 5-year overall survival rates were 16% in group A and 49% in group B (P=0.0002). The 5-year disease-specific survival rate was 23% in group A while in group B it was 49%; the difference was statistically significant (P=0.02). Combined treatment improves overall and disease-free survival in patients with stage II, III and IVA oral tongue cancer. In patients who are not candidates for surgery, the effect of radiotherapy may be increased with the use of brachytherapy.

The results of concomitant and sequential chemoradiotherapy with cisplatin and etoposide in patients with locally advanced non-small cell lung cancer.

PURPOSE: To report on the treatment results and demographic characteristics of patients with locally advanced non small cell lung carcinoma (NSCLC) who were treated with concomitant or sequential chemoradiotherapy. PATIENTS AND METHODS: 132 patients with locally advanced NSCLC (stage IIIB) were evaluated. Their median age was 60 years (range 33-80). Histopathological diagnosis was epidermoid carcinoma in 96 (73%) patients, adenocarcinoma in 33 (25%) patients and large cell carcinoma in 3 (2%) patients. Karnofsky performance status (KPS) score was >/= 70 in 112 (85%) patients. Weight loss was greater than 5% in 34 (26%) patients at presentation. One hundred and six (80%) patients were treated with sequential chemoradiotherapy which consisted of 3 monthly cycles of cisplatin (100 mg/m(2), day 1) and etoposide (100 mg/m(2)/day, days 1-3) before radiotherapy. Radiotherapy consisted of a total dose of 60 Gy in 30 fractions (2 Gy / fraction), given to a volume including primary tumor and mediastinum. Two to 4 cycles of chemotherapy were administered after completion of radiotherapy to patients whose disease had not progressed after initial chemotherapy. Twenty-six patients were treated with concomitant chemoradiotherapy. The same radiotherapy regimen was started with the 2nd cycle of chemotherapy which consisted of cisplatin (80 mg/m(2), day 1) and etoposide (100 mg/m(2)/day, days 1-3). Chemotherapy was completed after 4 cycles in all patients. RESULTS: Overall survival (OS) was 14.5 months in 106 patients treated with sequential chemoradiotherapy and 14.6 months in 26 patients treated with concomitant chemoradiotherapy (p=0.99). Median time to progression was 9.77 months in the concomitant group and 11.6 months in the sequential group (p=0.47). However, progression-free survival was better in patients of both groups whose KPS was >70 (12.4 months versus 11.5 months, p= 0.02). While presence of anemia was found as an adverse prognostic factor only in univariate analysis, non-epidermoid histology, KPS less than 70 and presence of N2-N3 disease were found as adverse prognostic factors in both univariate and multivariate analysis. CONCLUSION: The addition of chemotherapy to radiation concomitantly or sequentially prolongs survival in locally advanced NSCLC patients with acceptable adverse event profiles in both arms compared with results of the trials in the literature in which radiotherapy is used as single treatment modality.

Cerebellar and multiple spinal hemangioblastomas and intraventricular meningioma managed with subtotal resection and external beam radiotherapy; report of a case with literature review.

Hemangioblastomas are cystic, highly vascular benign neoplasms that constitute 1.5-2.5% of all intracranial tumors and 7-10% of primary posterior fossa tumors. They occur sporadically (80%) or in association with von Hippel-Lindau (VHL) disease (20%). This disease consists of multiple intracranial, retinal and spinal hemangioblastomas, pheochromocytoma, retinal angiomas, pancreatic cysts, renal cell carcinomas and adrenal tumors. Our patient was a 21-year-old male who presented with cerebellar and multiple spinal hemangioblastomas, and intraventricular meningioma. There was a positive family history (mother and brother) of VHL disease. Intracranial and spinal lesions were treated with external beam radiotherapy following subtotal excision of the cerebellar lesion. Three-year follow-up revealed radiologically stable lesions. Microsurgical resection remains the treatment of choice for the vast majority of symptomatic and sporadic cystic hemangioblastomas. However, since hemangioblastoma is a highly vascular tumor and local invasion of critical structures is frequent and multifocality is often a characteristic of the hemangioblastomas that are associated with VHL disease, subtotal excision is frequent and adjuvant therapies such as external beam radiotherapy or stereotactic radiosurgery represent a reasonable treatment in such cases.